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首页> 外文期刊>Journal of intensive care medicine >Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients: Systematic Review and Meta-Analysis
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Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients: Systematic Review and Meta-Analysis

机译：早期与肾脏替代疗法的早期开始患者患者：系统审查和荟萃分析

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Objective: Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. Methods: We searched the Medline (via Pubmed), LILACS, Science Direct, and CENTRAL databases from inception until November 2016 for randomized clinical trials (RCTs) or observational studies comparing early versus late initiation of RRT in critically ill patients. The primary outcome was mortality. Duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and renal function recovery were secondary outcomes. Meta-analysis and trial sequential analysis (TSA) were used for the primary outcome. Results: Sixty-two studies were retrieved and analyzed, including 11 RCTs. There was no difference in mortality between early and late initiation of RRT among RCTs (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.52-1.19; I-2 = 63.1%). Trial sequential analysis of mortality across all RCTs achieved futility boundaries at both 1% and 5% type I error rates, although a subgroup analysis of studies including only acute kidney injury patients was not conclusive. There was also no difference in time on mechanical ventilation, ICU and hospital LOS, or renal recovery among studies. Early initiation of RRT was associated with reduced mortality among prospective (OR = 0.69; 95% CI: 0.49-0.96; I-2 = 85.9%) and retrospective (OR = 0.61; 95% CI: 0.41-0.92; I-2 = 90.9%) observational studies, both with substantial heterogeneity. However, subgroup analysis excluding low-quality observational studies did not achieve statistical significance. Conclusion: Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with early initiation of RRT was limited to low-quality observational studies.
机译：目的：早期开始肾脏替代治疗（RRT）对危重病人的存活和肾脏回收率的影响仍然不确定。我们旨在系统地审查目前的证据，比较早期对危重病患者早期开始的结果。方法：我们从初始化的临床试验（RCT）或观察研究中搜查了Medline（Via PubMed），丁香，科学直接和中央数据库，比较了早期患者早期对RRT的早期开始的随机临床试验（RCT）或观察研究。主要结果是死亡率。机械通风的持续时间，重症监护室（ICU）住院长度（LOS），医院洛杉矶和肾功能恢复是二次结果。 Meta分析和试验顺序分析（TSA）用于主要结果。结果：检索和分析六十二项研究，包括11个RCT。在RCT之间的早期和晚期开始之间的死亡率没有差异（差距[或] = 0.78; 95％置信区间[CI]：0.52-1.19; I-2 = 63.1％）。所有RCT的试验顺序分析所有RCT的死亡率都取得了1％和5％I型错误率的无用界限，尽管亚组的研究分析包括急性肾损伤患者并非决定。在机械通风，ICU和医院洛杉矶或研究中的肾脏复苏也没有差异。 RRT的早期开始与前瞻性的死亡率降低（或= 0.69; 95％CI：0.49-0.96; I-2 = 85.9％）和回顾（或= 0.61; 95％CI：0.41-0.92; I-2 = 90.9％）观察性研究，具有实质性的异质性。然而，不包括低质量观察研究的亚组分析没有达到统计学意义。结论：随机试验的汇总分析表明RRT的早期起始与降低死亡率无关。降低与RRT的死亡率降低的潜在益处仅限于低质量的观察研究。

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